Liver Cancer Flashcards
What is the main type of primary liver tumour?
Hepatocelluar carcinoma (HCC)
What is the cause of HCC?
Chronic inflammatory process - viral hepatitis or chronic alcholism
What are the risk factors for HCC?
Viral hepatitis - B and C High alcohol intake Smoking Advanced age (>70) Aflatoxin exposure - found in cereals and nuts FH of liver disease
What are the clincial feature of HCC?
Similar to liver cirrhosis - vague symptoms
Dull ache in the right upper abdomen - uncommen
Advanced disease - signs of liver failure
Examination - irregular, enlarged craggy and tender liver
What are the differential diagnosis for HCC?
Infectious hepatitis
Cardiac failure- smooth hepatomegaly
Bengin hepatocelluar adenoma
Other causes of liver cirrhosis
What investigation should be ordered to diagnose HCC?
Bloods - LFTS and coag screen (AST:ALT>2 - alcoholic liver disease, AST:ALT around 1 - viral hepatitis)
AFP - alpha fetoprotein - monitor response to treatment
Ultarsound
MRI liver scan
CT staging
Last resort - if unsure - biposy or percutaneous FNA
What is the most accpeted staging system for HCC?
Barcelona clinic liver cancer staging system (BCLC)
What are some risk assessment tools used for HCC?
Child-Pugh score
MELD score
What are the only curtaive option for HCC and when are they used?
Surgical resection - pts without cirrhosis and good baseline health
Transplantation - if meet Milan criteria:
- One lesion is smaller than 5cm or three lesions are smaller than 3cm
- There are no extrahepatic manifestations
- There is no vascular infiltration
What are the non-surgical options for HCC and when are they used?
Image-guided ablation - early HCC (BCLC 0 or A)
Alcohol ablation - well-functioning livers, small inoperable cancers
Transarterial chemoembolisation (TACE) - BCLC stage B - high conc of chem drugs sre injected directly into hepatic artery and embolising agent is added.
What is the median survival time for HCC?
6 months but depends on each individual
